Prevalence and Pattern of Nodal Metastases in Ovarian Malignancy: A Perioperative Audit

Abstract

It is still unclear whether or not full nodal dissection and detailed staging offer any benefits. Little is known regarding the degree of nodal involvement based on histotype. We aimed to assess the lymphatic dissemination patterns and prevalence in early-stage epithelial ovarian cancer and identify the underlying risk factors for nodal metastases. This is a prospective study conducted over a period of three years. Institutional ethics committee approval has been obtained. A total of 157 consecutive patients with apparently early-stage ovarian cancer, who were treated at the Department of Gynecologic Oncology, Acharya Harihar Post Graduate Institute of Cancer (AHPGIC) from January 2020 to January 2023, were included. The most frequent grade was 3 (66.8%), and the most common histotype was high-grade serous ovarian cancer (HGSOC; 55.4%), followed by mucinous (16.5%) and endometrioid (14.01%) varieties. Seromucinous and clear cell ovarian cancers were found infrequently. The most common pattern was isolated pelvic nodal involvement in 48.9% of patients, followed by both para-aortic and pelvic nodal involvement in 25.5% of patients; 13 patients had isolated para-aortic nodal involvement. HGSOC was most commonly associated with isolated metastasis to the pelvic lymph nodes alone, while the endometrioid variety was prone to both pelvic and para-aortic spread. Out of the 55 patients with nonserous tumors, 12.72% exhibited nodal involvement. Most nonserous tumors showed affinity for both pelvic and para-aortic (42.85%) nodal metastases. Only grade 3 and serous histology showed a positive association with nodal metastasis. Approximately 45.2% of cases showed upstaging after surgical staging procedures. Multicentric studies are essential to analyze the prognostic impact of systematic lymphadenectomy in ovarian carcinoma patients, depending on the histotype and distribution pattern of nodal metastases.